Online Registration

NZ ACADEMY OF COSMETIC DENTISTRY

3RD BIENNIAL SCIENTIFIC SYMPOSIUM 2009

Bridging the Gap

18, 19 June 2009  - Crowne Plaza Auckland

Please fill in one Registration form per attendee so we have your contact details.
Enter group bookings for the Social Programme only once per group. 
Note all members of a group in the Comments field for the main registrar.
Opening Reception at the Comedy Club is limited to first 100 Registrants.

CONTACT DETAILS
Title	Ms Mrs Mr Dr	Req
Full Name		Req
Role	Dentist Technician Staff Hygienist	Req
Company / Practice		Req
Telephone		Req
Mobile
Email		Req
Address - PO Box
Address - Street
Address - Suburb
Address - City
Address - Postcode
Are you an existing Member of the NZACD?	Yes No Join Now (Membership fee $365 inc per annum)
FULL REGISTRATION
Dentist / Technician	Member $1,198 Non-member $1,398
Hygienist	$650
Staff	$350
ONE DAY REGISTRATION
Nominate your preferred day	Thursday Friday
Dentist / Technician	$700
Hygienist	$350
Staff	$195
SOCIAL PROGRAMME
Opening Reception: Comedy Club Wednesday June 17 Limited to first 100 registrants	Yes I will be attending this event (1 complimentary) Plus Additional tickets at $50 per head
2009 Dental Expo Grand Opening Cocktails Thursday June 18	Yes I will be attending this event Plus Additional people (complimentary event)
Dental Masquerade Ball Friday June 19	Total people attending at $145 / head or $1250 / table of ten
COMMENTS
Comments, names of your party, any general enquiries